The Battle Against Recurrent Prostate Cancer
- Hopper was diagnosed for a second time in October of 2009, after first being treated for prostate cancer ten years earlier.
- The cancer spread to his bones and he died on May 29, 2010.
- Advances in treatment for metastatic prostate cancer have improved outlook for men with the disease.
Hopper played a former bomb-squad officer turned terrorist in 1994’s Speed with Keanu Reeves and Sandra Bullock.
But it was Hoosiers, in which he played an alcoholic ex-basketball star, that earned him an Academy Award nomination.
Although prostate cancer often exhibits no symptoms, in Hopper’s case, he was hospitalized for stomach pain and flu-like symptoms before being diagnosed in October of 2009. This was a recurrence of the disease which, according to the New York Times, which Hopper said had been first diagnosed ten years earlier.
The cancer had spread to his bones and he died on May 29, 2010. He was appearing in a television version of the movie Crash at the time. Weeks before his death, Hopper looked frail when he received a star on the Hollywood Walk of Fame, surrounded by friends including Jack Nicholson, actor Viggo Mortensen, and Blue Velvet director, David Lynch.
Navigating Advanced Prostate Cancer
About 1 man in 9 will be diagnosed with the disease in his lifetime. Aside from skin cancer, prostate cancer is the most common cancer in American men, according to The American Cancer Society. In many cases, prostate cancer is slow-growing but when the disease is advanced, spreading to other parts of the body, it’s called metastatic.
To fight this advanced form of the disease hormone therapy has shown enormous promise, especially when given in combination with chemotherapy. Hormone therapy drugs work by reducing the levels of male hormones — including testosterone — that can stimulate the growth of prostate cells (including cancerous ones).
“If we take away testosterone, we can shrink down the tumor and hold it in check for often years and years and years,” Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, told SurvivorNet.
However, some tumors can stop responding to hormonal therapy. In that case, chemotherapy alone can provide relief from symptoms, if not a cure.
“One of the things about chemo that’s really underappreciated,” Dr. Freedland noted, “the cancer in the bones can cause a lot of pain, and so when they go on the chemotherapy, the pain gets better.” It can also extend the life of patients with metastatic disease.
“What we’re finding now is if we give it earlier, much earlier, we can actually have very profound effects on extending life,” Dr. Freedland said. ” Not just a couple of months but by a year and a half when done earlier.”
Genetic Testing Can Guide Treatment Decisions
Doctors are now considering testing the inherited genetics of all men with advanced prostate cancer, ideally at diagnosis, in order to understand their disease better.
Not only will it provide clues as to how to treat the cancer, says Dr. Eli Van Allen, a medical oncologist at Dana-Farber Cancer Institute, but it may also reveal the cancer’s genetic tendency to behave in a certain way, which is a vital predictor for how to treat.
In addition, learning whether you have a genetic cancer gene will be extremely significant for other family members, since men with a family history are considered high risk and need to be screened at a much younger age.
The Gleason Score: Determining Treatment
Doctors categorize prostate cancer cells according to their aggressiveness using the Gleason Score. The numbers range from 6 to 10 and are based on how atypical the cells look. To calculate a Gleason grade, the pathologist will study the tumor cells taken from a biopsy and see how the cells are organized. The higher the score, the more aggressive the cancer.
A Gleason score will let oncologists know when to wait and watch or when to treat, assuming the patient is young enough (under age 70) to benefit from treatment. Lower numbers translate into better risk factors, and different doctors may approach treatment differently.
Dr. James Brooks, Chief of Urologic Oncology at Stanford Medicine says the Gleason Score determines how aggressive a prostate cancer is and helps guide treatment decisions.
Patients who have high-risk cancer, meaning they have high Gleason scores and a high PSA (over 20), will usually be treated aggressively. Studies show that patients who fall somewhere in the middle are likely to benefit from treatment because it prolongs life expectancy.
Still, the decision on what approach to choose will depend on several factors, including the risk-benefit ratio of the treatment options.